MEDICARE: DR. DIMPLE KAPOOR O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WV0400X	Vision Therapy Optometrist	0618001301	VA
2	152WX0102X	Occupational Vision Optometrist	0618001301	VA
3	152W00000X	Optometrist	0618001301	VA
4	152WC0802X	Corneal and Contact Management Optometrist	0618001301	VA
5	152WL0500X	Low Vision Rehabilitation Optometrist	0618001301	VA
6	152WP0200X	Pediatric Optometrist	0618001301	VA
7	152WS0006X	Sports Vision Optometrist	0618001301	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	412132083	OTHER	VA	GREATWEST
2	173375	OTHER	VA	ANTHEM
3	2131697	OTHER	VA	UNITED HEALTH CARE
4	412132083	OTHER	VA	NCAS
5	2286069	OTHER	VA	FIRST HEALTH
6	3790430	OTHER	VA	AETNA
7	9364952	OTHER	VA	GUARDIAN
8	J701-0002	OTHER	VA	BCBS CAREFIRST
9	692491	OTHER	VA	NCPPO
10	J701-0020	OTHER	VA	BCBS CAREFIRST
11	9364952	OTHER	VA	P.H.C.S

General Provider Information

NPI Number	:	1902831134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMPLE KAPOOR O.D.

Provider Business Mailing Address
First Line	:	25055 RIDING PLZ STE 100
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-957-3384
Fax Number	:	703-961-9230

Provider Business Practice Location Address
First Line	:	25055 RIDING PLZ STE 100
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-961-9119
Fax Number	:	703-961-9230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/11/2022

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